Full Text of HB5355 103rd General Assembly
HB5355eng 103RD GENERAL ASSEMBLY | | | HB5355 Engrossed | | LRB103 37186 RPS 67305 b |
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| 1 | | AN ACT concerning health. | 2 | | Be it enacted by the People of the State of Illinois, | 3 | | represented in the General Assembly: | 4 | | Section 5. The Department of Public Health Powers and | 5 | | Duties Law of the Civil Administrative Code of Illinois is | 6 | | amended by adding Section 2310-730 as follows: | 7 | | (20 ILCS 2310/2310-730 new) | 8 | | Sec. 2310-730. Nonopioid alternatives pamphlet. The | 9 | | Department of Public Health shall develop and publish on its | 10 | | website an educational pamphlet regarding the use of nonopioid | 11 | | alternatives for the treatment of acute nonoperative, acute | 12 | | perioperative, subacute, or chronic pain. The pamphlet shall, | 13 | | at a minimum, conform with the most current CDC Clinical | 14 | | Practice Guideline for Prescribing Opioids for Pain published | 15 | | by the Centers for Disease Control and Prevention and shall | 16 | | include: | 17 | | (1) information on available nonopioid alternatives | 18 | | for the treatment of pain, including available nonopioid | 19 | | medicinal drugs or drug products and nonpharmacological | 20 | | therapies; and | 21 | | (2) the advantages and disadvantages of the use of | 22 | | nonopioid alternatives. |
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| 1 | | Section 10. The Illinois Insurance Code is amended by | 2 | | adding Section 370c.3 as follows: | 3 | | (215 ILCS 5/370c.3 new) | 4 | | Sec. 370c.3. Coverage for nonopioid medications; pain | 5 | | relief parity. | 6 | | (a) In this Section, "health insurance issuer" has the | 7 | | meaning set forth in Section 5 of the Illinois Health | 8 | | Insurance Portability and Accountability Act. | 9 | | (b) Notwithstanding any provision of law to the contrary, | 10 | | when a licensed health care practitioner prescribes a | 11 | | nonopioid medication for the treatment of acute pain, it shall | 12 | | be unlawful for a health insurance issuer to deny coverage of | 13 | | the nonopioid prescription drug in favor of an opioid | 14 | | prescription drug or to require the patient to try an opioid | 15 | | prescription drug prior to providing coverage of the nonopioid | 16 | | prescription drug. | 17 | | (c) In establishing and maintaining its drug formulary, a | 18 | | health insurance issuer shall ensure that no nonopioid drug | 19 | | approved by the United States Food and Drug Administration for | 20 | | the treatment or management of pain shall be disadvantaged or | 21 | | discouraged, with respect to coverage or cost sharing, | 22 | | relative to any opioid or narcotic drug for the treatment or | 23 | | management of pain on the health insurance issuer's drug | 24 | | formulary, where impermissible disadvantaging or | 25 | | discouragement includes, without limitation: imposing more |
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| 1 | | restrictive coverage criteria on any such nonopioid drug than | 2 | | the least restrictive coverage criteria imposed on an opioid | 3 | | or narcotic drug; establishing more restrictive or more | 4 | | extensive utilization controls, including, but not limited to, | 5 | | more restrictive or more extensive prior authorization or step | 6 | | therapy requirements, for such nonopioid drug than the least | 7 | | restrictive or extensive utilization controls applicable to | 8 | | any such opioid or narcotic drug; or, if the health insurance | 9 | | issuer maintains a drug formulary grouped into tiers for the | 10 | | purposes of determining cost sharing, placing any such | 11 | | nonopioid drug on a tier that requires a cost-sharing | 12 | | responsibility that exceeds the lowest cost-sharing | 13 | | responsibility required for any opioid or narcotic drug on the | 14 | | drug formulary. This subsection does not preclude opioid drugs | 15 | | from being preferred over other opioid drugs or nonopioid | 16 | | drugs from being preferred over other nonopioid drugs. | 17 | | Section 15. The Illinois Public Aid Code is amended by | 18 | | adding Section 5-55 as follows: | 19 | | (305 ILCS 5/5-55 new) | 20 | | Sec. 5-55. Coverage for nonopioid medications; pain relief | 21 | | parity. | 22 | | (a) Required coverage for nonopioid medications. | 23 | | Notwithstanding any provision of law to the contrary, whenever | 24 | | a licensed health care practitioner prescribes a nonopioid |
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| 1 | | medication for the treatment of acute pain, neither the | 2 | | Department nor a managed care organization contracted with the | 3 | | Department shall deny coverage of the nonopioid prescription | 4 | | drug in favor of an opioid prescription drug or require a | 5 | | patient to try an opioid prescription drug prior to providing | 6 | | coverage of the nonopioid prescription drug. | 7 | | (b) Pain relief parity. In establishing and maintaining | 8 | | the Illinois Medicaid Preferred Drug List, the Department | 9 | | shall ensure that nonopioid drugs preferred on the | 10 | | Department's preferred drug list, and approved by the U.S. | 11 | | Food and Drug Administration, for the treatment or management | 12 | | of pain shall not be disadvantaged or discouraged with respect | 13 | | to coverage relative to any opioid or narcotic drug for the | 14 | | treatment or management of pain. | 15 | | Section 99. Effective date. Sections 10 and 15 of this Act | 16 | | take effect January 1, 2026. |
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